Are You Missing Out on the Most Up-To-Date Procedures?

Don’t miss out on the latest state-of-the-art medical procedures.

by Meryl Davids Landau

Photograph: Illustrated by Bryan Christie

Whether it’s a new treatment technique or a different way of performing your regular checkups, modern medicine is always coming up with advances and breakthroughs. But that doesn’t mean you’ll hear about them from your doctor. Some physicians are slow to embrace change, perhaps because they are waiting for more evidence that the latest way is better than the old way, or because they’re unwilling to invest in learning the new technique or buying the new equipment, or simply because they feel that innovation isn’t warranted in certain situations. But if a breakthrough is going to be bypassed, you should know it—and decide whether you want to seek the new procedure elsewhere. Here, several top-of-the-line techniques to ask about before you book a procedure.

Some 25 years ago, after my gynecologist found a lump in my breast, he shipped me off to the OR, dug out the
whole tumor and biopsied it. The wound bled for days and I still sport a two-inch scar, but the tumor was benign and I am not complaining. At that time, open surgical biopsy was standard practice, but technological advances of the last two decades should have rendered that procedure nearly obsolete. Working on an outpatient basis, doctors can now use ultrasound, MRIs or stereotactic navigation to guide a thin needle into the skin to remove tissue samples for biopsy, which allows for a definitive diagnosis and enables the patient to recover almost immediately. Indeed, a 2009 conference of top cancer doctors agreed that these minimally invasive needle biopsies represent the “best practice” for diagnosis in almost all cases.

Yet a recent study found that a stunning 40 percent of biopsies by breast and general surgeons at one top-ranked institution are still done via the more invasive technique. This means some women are needlessly undergoing a major surgical procedure, says Beth DuPree, MD, medical director of the breast health program at Holy Redeemer Health System in Meadowbrook, Pennsylvania.

If your doctor recommends an open biopsy after a lesion is found, ask why. “There are a few valid reasons to get an open surgical biopsy, such as when the tumor is close to the chest wall,” explains Judy Kneece, RN, author of The Breast Cancer Treatment Handbook. (DuPree notes that her open biopsy rate is about two percent.) “But if your doctor says, ‘That’s how I always do it,’ or she doesn’t give a good justification, absolutely get a second opinion,” Kneece says. Most comprehensive breast centers are equipped to perform minimally invasive biopsies.

High-Definition Colonoscopy: Checks the health of your large intestine

Watch an HD TV set and you actually see the pores and pimples of the actors. So it only makes sense that using high-definition colonoscopy equipment—which includes an HD video chip attached to the tip of the endo­scope plus a higher-resolution HD monitor to see the results—gives physicians a much better view of your colon. When researchers at the Mayo Clinic in Jacksonville, Florida, reviewed more than 2,400 colonoscopies that had been performed there, they discovered that the enhanced equipment detected 20 percent more precancerous polyps than did the traditional apparatus. The difference was most pronounced when the growths were small (less than 10 millimeters, or smaller than a half inch). While it hasn’t been proven that spotting and removing these small growths saves lives, most experts believe it’s prudent to have them excised.

Even though it’s not clear how many medical centers use the HD procedure, it is undoubtedly becoming more prevalent. Ask in advance if the physi­cian performing your colonoscopy has this option available.